Time of day, not length of shift, may have greater impact on resident fatigue

By Shahmyna Kassam

New research led by The Hospital for Sick Children (SickKids) is questioning common assumptions that shorter shifts make doctors less tired and are safer for patients. One of the ongoing challenges in health care is providing high-quality care 24/7 while managing fatigue in health-care professionals. To address this issue, there has been a movement to reduce the duration of overnight duty to reduce fatigue and improve patient safety.

The new study, funded by the Canadian Institutes of Health Research (CIHR) and the University of Toronto’s Centre for Quality Improvement and Patient Safety, was published Feb. 9, 2015 in the Canadian Medical Association Journal (CMAJ). Dr. Christopher Parshuram, Critical Care Physician and Senior Scientist at SickKids, with collaborators from the Canadian Critical Care Trials Group, conducted a randomized trial assessing resident duty-hour schedules in two adult intensive care units.

The research team found residents assigned to shorter (12- or 16-hour) duty periods did not feel less tired than those working the 24-hour overnight schedule; in fact, residents across all three groups showed similar levels of fatigue at 4 a.m., regardless of the schedule, suggesting that time of day may be a more important determinant of fatigue than length of shift.

The overall rate of harmful errors was low; however, most of these harmful errors occurred in the 12-hour schedule. Longer schedules were associated with more severe fatigue-related symptoms, with residents on the 24-hour shifts reporting more headaches, eye pain, nausea and other symptoms.

Future research may explore these areas, as well as the effects of schedules on the quality of resident education.

Dr. Parshuram is an Associate Professor in the Department of Paediatrics and Director of Paediatric Patient Safety Research at the Centre for Quality Improvement and Patient Safety at the University of Toronto.